Legionella widespread at Oakland VA

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Not even the landscaping was safe.

Legionella bacteria became so pervasive in the Pittsburgh VA's Oakland hospital that it contaminated an outdoor decorative fountain, making the water feature one possible source in the fatal outbreak of Legionnaires' disease revealed during the fall, the Centers for Disease Control and Prevention found.

A 56-page CDC report obtained by the Tribune-Review outlines stark details in the case, including that workers super-heated and flushed pipes at the hospital a half-dozen times from January 2011 to October 2012.

VA officials first told the public of hospital-linked Legionnaires' cases in mid-November, about two weeks after the CDC first told the VA that in-house bacteria were causing pneumonia.

The repeated super-heating makes it “pretty clear they recognized there was a problem,” said Janet Stout, a former VA official, Legionnaires' researcher and co-founder of the Special Pathogens Laboratory, Uptown. “The fact that they had to do it repeatedly suggests that it was not done hot enough and long enough.”

A Pittsburgh VA spokesman could not be reached for comment Monday.

Sen. Bob Casey Jr., D-Scranton, who sparked an internal investigation at the VA, said the CDC report “still leaves many unanswered questions.”

“It is imperative that these events are reported appropriately to both the CDC and the public in order to keep people both safe and informed,” he said.

VA leaders say they sought CDC help late last year in evaluating the outbreak of Legionnaires', a waterborne and sometimes-fatal form of pneumonia. They had acknowledged only five cases linked to hospital tap water contaminated with Legionella, the bacteria that causes the disease.

A bombshell summary of CDC findings released last week at a congressional hearing showed 21 cases since January 2011 probably originated at the Oakland hospital or the VA's H.J. Heinz Campus in O'Hara. Five of those patients died.

The Pittsburgh VA said Friday another Legionella-infected patient died in late January, though it remains unclear whether that veteran came in contact with the bacteria in the Oakland hospital or elsewhere.

The complete CDC report dated Jan. 25 illustrates more detail found by the federal reviewers, who are tracing the outbreak's genesis before 2011, the document shows. Among highlights in the report sent to the VA and state Health Department by Dr. Alicia Demirjian in the CDC Division of Bacterial Diseases:

• Legionella was “widespread throughout the hospital” in Oakland by fall 2012. Sixty-six percent of environmental samples collected by the CDC in November showed Legionella growth at the Oakland hospital. One round of tests found “every water sample we took was positive for Legionella except for hot water collected from two stand-alone hot-water heaters,” the report reads.

• In some instances, reviewers discovered a delay of more than two days in relaying patients' Legionella-positive test results from the hospital laboratory to an internal infection-prevention team. The prevention team “does not typically contact (the doctors) with results,” though it did meet with an administrator for infectious diseases to classify Legionnaires' cases.

• Systems that use copper and silver ions were supposed to prevent Legionella in the tap water. Only seven of 11 samples found copper and silver levels were within a manufacturer's guidelines for Legionella control.

• Extensive construction at the hospital probably contributed to the Legionella outbreak.

Rep. Tim Murphy, R-Upper St. Clair, voiced concern about the delay between the discovery of Legionella in the hospital lab and when the lab got word out. Former VA official Dr. Victor Yu, a University of Pittsburgh professor whom the VA fired, called it “incomprehensible that they didn't tell physicians that Legionella had re-entered the drinking water.”

“If there was a fire in the building, would you pull the fire alarm and call 911, or would you send the fire department a letter?” Murphy said.

Dr. Ronald Voorhees, the acting health director for Allegheny County, said he felt the VA's actions “have been on target.”

“I think there have been hiccups along the way,” Voorhees said. “But once they recognized they had a problem, they took action to treat all their water.”

He said he was still reviewing the CDC report and would be “looking into appropriate responses.”

“I think the bigger issue is that we know water systems — not just at the VA — have Legionella,” Voorhees said. “We are in desperate need of having a certified method for how to deal with it.”

A congressional subcommittee under the House Committee on Veterans' Affairs is weighing federal standards for Legionella prevention. County and VA standards have long held that hospitals should be concerned when testing finds Legionella in more than 30 percent of samples.

Federal epidemiologist Lauri Hicks told the congressional subcommittee Feb. 5 that the CDC knows of no safe level for Legionella.

Staff writer Mike Wereschagin contributed to this report. Adam Smeltz is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or asmeltz@tribweb.com.

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